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fM E�+ry�Mn <br />C�T' OF <br />everett <br />BUiLDING DEPARTMENT <br />259•8B 10 <br />.°i'::, f ;1�1 <br />'r:PPLICATiON FO�:'' <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />everen <br />� <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br />�OWHEP �nAII�DOPE55 Gltt ZIP PnONE <br />C'ARL c-; �j.�c �LSIN y��/y-Gi�AN/7�14',E i`✓L-i2Fi i 9�1�3 2-s`y-/Z�l <br />OENEPALCONiR�L�O� M�Il�00i�C55 CIIY ll� PPONC LICENSE• <br />%iI I UI �1?, <br />MEGUNIf.4 CON1R�ClOq M�IL �ODRC55 C�IY IiP PHON[ LILOISC • <br />PLUM0INOCONiRAG10R M��L AOD�[55 CrtV ZIP PIIONE IICENSC • <br />QV NEyy ❑ ADOITION ❑ ALTEI7ATION ❑ Rf:f'AI(i ❑ DEMOLIIION <br />,. //VS:,4GL <br />� USEOf BWIC _ DING <br />�� <br />✓ TT <br />1E0�� OESCRIPiION O� ^q <br />w�_ewc�_ <br />k <br />PLUMSIN6 <br />� KITCMEN SINK 6 DISP. <br />� j OISMWIISHEN <br />� IAUNDRY TRI1Y <br />�f . Cb1MESw�SHER <br />UFINAI <br />" � ORINNINO FOUNTAIN <br />FLOOR DRPIN ' <br />BACKFLOW PNEVENTERS - <br />t ROOF�RAINS—R�INLEAOERS <br />SINK �SERVICE —BAR. ETC.) <br />`� <br />� <br />1 <br />SUlTOTAL s <br />PERMIT 3 <br />� �� TOT11L FEE f <br />� VPONISEIB�CK RE�RSETBACN SIDESEiB�CN <br />� USELONE LOT�REA. y�C�NTSRE <br />' . . DYES ONO <br />iTYV[OLCON51. OCCUP�NCVGROUP NO.OF�WELLINGWIli9 <br />� <br />i Si2E OF BIDG. NO Of S10RIE4 MA%ACC. lOAO <br />� <br />� <br />� FIRE SPRINHLERS REOUIRED ❑ YES ❑ NO <br />i APFLIGRIION�CCOY PLA��SCHEGMEDBY APPPfORI55UANCEBY <br />WOOOSTOVE?Ilf'L.INSERT ❑ DUIL�M(i ItELOC�IION <br />I HEREEIY CEFTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATION AND KNOW 7HE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWS AND OFlDINANCES GOVERNINGTHISTYPE <br />OF WORN. WILL BE C�'�'�LETGD WITH WHETHERSPEGFIEO HERE <br />INORNOT.TH[G�' �J�OFAPERMITDOESNOTPRESUMETO <br />GIVE AUT40RIT1' - :IOLATE OR CANCEL THE PROVISIONS OF <br />ANY O1HER STATE ON LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PE9FORMANCE OF CONSTRUCTION. . <br />SIQN�IUPEOFCONTRACiOROPAUIMORIZEOAGENT [IFTE <br />X �� . % �7,�C=-- L—> —5'� <br />MECHANICAL <br />[�7� <br />MC — MHNDLO UNITS — M.P. <br />PEFRIGERATION UNITS —HP. EA. <br />BOILERS — B.T.U.MP. <br />O�5 FIRED A.C. UNITS — B.T.U. <br />FORCED AIR SYSTEMS — 8 T.U. <br />WALL MEATEHS — B,T U. <br />�UNIT HEATERS — B.T.U. <br />VENTIUTION FAN <br />RANGEMOOD <br />W�TER HEATER <br />WOODSTOVE � <br />METAL FIREPLACE d CHIMNEV <br />F�REPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUBTOTAL <br />PERMIT <br />T0TI1L FEE <br />P�AN CHECN NUMBER I FEE <br />ouaoiNc S <br />PLUMBING <br />MECHANICAL <br />M EA. <br />M <br />M <br />PECEIPT NO. <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATEENERG�SURCHARGE <br />PUOLIC�4'ORKS <br />TOTAL <br />PROPERTY OWNERS FRE RESPONSIBLE FOR UETERAIINING ALl <br />PROPEFN LINE LOCA710NS AND RELATED EASEMENTS. <br />